Provider Demographics
NPI:1275137572
Name:STALLO, DENNIS LEE
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:LEE
Last Name:STALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 MCCAULY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1492
Mailing Address - Country:US
Mailing Address - Phone:513-260-3714
Mailing Address - Fax:
Practice Address - Street 1:5229 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1602
Practice Address - Country:US
Practice Address - Phone:513-731-2600
Practice Address - Fax:513-731-4618
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03310612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist